Former U.S. Secretary of Labor Robert Reich. (photo: RADiUS-TWC)
13 May 14
ccording to a report
released last week in the widely-respected health research journal, The
Lancet, the United States now ranks 60th out of 180 countries on
maternal deaths occurring during pregnancy and childbirth.
To put it bluntly, for every 100,000 births in America last year, 18.5 women died. That’s compared to 8.2 women who died during pregnancy and birth in Canada, 6.1 in Britain, and only 2.4 in Iceland.
A woman giving birth in America is more than twice as likely to die as a woman in Saudi Arabia or China.
You might say international comparisons should be
taken with a grain of salt because of difficulties of getting accurate
measurements across nations. Maybe China hides the true extent of its
maternal deaths. But Canada and Britain?
Even if you’re still skeptical, consider that our rate
of maternal death is heading in the wrong direction. It’s risen over
the past decade and is now nearly the highest in a quarter century.
In 1990, the maternal mortality rate in America was 12.4 women per 100,000 births. In 2003, it was 17.6. Now it’s 18.5.
That’s not a measurement error because we’ve been
measuring the rate of maternal death in the United States the same way
for decades.
By contrast, the rate has been dropping in most other nations. In fact, we’re one of just eight nations
in which it’s been rising. The others that are heading in the wrong
direction with us are not exactly a league we should be proud to be a
member of. They include Afghanistan, El Salvador, Belize, and South
Sudan.
China was ranked 116 in 1990. Now it’s moved up to 57.
Even if China’s way of measuring maternal mortality isn’t to be
trusted, China is going in the right direction.
We ranked 22 in 1990.
Now, as I’ve said, we’re down to 60th place.
Something’s clearly wrong.
Something’s clearly wrong.
Some say more American women are dying in pregnancy
and childbirth because American girls are becoming pregnant at younger
and younger ages, where pregnancy and birth can pose greater dangers.
This theory might be convincing if it had data to
support it. But contrary to the stereotype of the pregnant young
teenager, the biggest rise in pregnancy-related deaths in America has
occurred in women 20-24 years old.
Consider that in 1990, 7.2 women in this age group
died for every 100,000 live births. By 2013, the rate was 14 deaths in
this same age group – almost double the earlier rate.
Researchers aren’t sure what’s happening but they’re
almost unanimous in pointing to a lack of access to health care, coupled
with rising levels of poverty.
Some American women are dying during pregnancy and
childbirth from health problems they had before they became pregnant but
worsened because of the pregnancies — such as diabetes, kidney disease,
and heart disease.
The real problem, in other words, was they didn’t get adequate health care before they became pregnant.
Other women are dying because they didn’t have the means to prevent a pregnancy they shouldn’t have had, or they didn’t get the prenatal care they needed during their pregnancies. In other words, a different sort of inadequate health care.
One clue: African-American mothers are more than three times as likely to die as a result of pregnancy and childbirth than their white counterparts.
The data tell the story: A study by the Roosevelt
Institute shows that U.S. states with high poverty rates have maternal
death rates 77 percent higher
than states with lower levels of poverty. Women with no health
insurance are four times more likely to die during pregnancy or in
childbirth than women who are insured.
What do we do about this? Yes, of course, poor women
(and the men who made them pregnant) have to take more personal
responsibility for their behavior.
But this tragic trend is also a clear matter of public choice.
But this tragic trend is also a clear matter of public choice.
Many of these high-poverty states are among the
twenty-one that have so far refused to expand Medicaid, even though the
federal government will cover 100 percent of the cost for the first
three years and at least 90 percent thereafter.
So as the sputtering economy casts more and more women into near poverty, they can’t get the health care they need.
Several of these same states have also cut family planning, restricted abortions, and shuttered women’s health clinics.
Right-wing ideology is trumping the health needs of millions of Americans.
Let’s be perfectly clear: These policies are literally killing women.
Chancellor's Professor of Public Policy at the
University of California at Berkeley and Senior Fellow at the Blum
Center for Developing Economies, was Secretary of Labor in the Clinton
administration. Time Magazine named him one of the ten most effective
cabinet secretaries of the twentieth century. He has written thirteen
books, including the best sellers "Aftershock" and "The Work of
Nations." His latest, "Beyond Outrage," is now out in paperback. He is
also a founding editor of the American Prospect magazine and chairman of
Common Cause. His new film, "Inequality for All," is available on
Netflix, iTunes, DVD, and On Demand.
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